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Consortia should have to set up 'clinical senates'

The term 'GP-led commissioning' should be binned, and consortia forced to consult with other clinical specialists before making changes says NHS Future Forum experts.

The report - published today - says GPs should retain overall accountability for decision making, but they will have to set up and consult multi-specialty ‘senates'.

The report backs away from compulsory places for hospital consultants on consortia boards, saying giving all clinical specialists a seat on new NHS commissioning consortia would make them too large to be effective.

But answering concerns that GPs may have a conflict of interest as commissioners and providers of services - which may undermine the doctor-patient relationship - the report says there must be a ‘clear obligation' on commissioning boards to involve all those with a contribution to make in the design of services.

It also recommends that the terms ‘GP-led commissioning' and ‘GP commissioning consortia' should be abandoned in favour of 'clinical commissioning' or simply 'commissioning'.

'It is neither desirable or practical for the governing bodies of consortia to be representative of every group,' the report says.

‘We recognise the unique role of GPs who are tied in through their practice contracts to commissioning consortia and who therefore will have overall accountability for the decisions made by commissioning consortia.'

Wary of creating an extra layer of bureaucracy, the report suggests that clinical senates can be flexible structures based around existing clinical networks. Sometimes they could operate to a 'task and finish' remit.

The report also urges that contracts and payment mechanisms should be used to ensure that there are incentives to promote evidence-based practice, data collection and quality outcomes.

'There should be further work to ensure tariff arrangements support the commissioning of joined up care pathways and that payment arrangements provide the right incentives and rewards for high quality care.'

Consortia should have to set up 'clinical senates' More on the NHS Future Forum report of the listening exercise